Diabetic ketoacidosis (peds): Difference between revisions
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*(pH <7.25-7.30 or bicarb <15) + hyperglycemia (>300) + ketonemia (>1:2 serum dilution)
*(pH <7.25-7.30 or bicarb <15) + hyperglycemia (>300) + ketonemia (>1:2 serum dilution)
*DKA + AMS = cerebral edema until proven otherwise
*DKA + AMS = cerebral edema until proven otherwise
==Cerebral Edema==
===Risk Factors===
#Age <5yo
##Rare in >20yo
#Severe hyperosmolality
#Failure of Na to rise w/ therapy
#Severe acidosis
#Overaggressive fluid resus is NOT a risk factor
===Diagnosis===
*Begins 6-12hr after onset of therapy
*Many appear to be improving from their DKA before deteriorating from cerebral edema
*Premonitory symptoms:
**HA, declining mental status, sz, respiratory arrest
===Treatment===
*Mannitol 0.5-1gm/kg IV bolus over 20 minutes; give a repeat does if there is an inadequate response. If 2 doses of mannitol are ineffective, consider 3% saline 10mL/kg over 30min.
*Fluid restriction - decrease the IVF infusion rate by 30%


==General Treatment==
==General Treatment==
*IV Fluids
*[[IV Fluids]]
**NS @ 10ml/hr/kg for stable VS
**NS @ 10ml/hr/kg for stable VS
**Bolus 20ml/kg NS only for unstable VS
**Bolus 20ml/kg NS only for unstable VS
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**pH >7.35 and bicarb >20
**pH >7.35 and bicarb >20
**Known and resolving precipitant for DKA
**Known and resolving precipitant for DKA
==Complications==
*[[Cerebral Edema in DKA]]


==See Also==
==See Also==

Revision as of 08:08, 29 April 2014

Background

  • (pH <7.25-7.30 or bicarb <15) + hyperglycemia (>300) + ketonemia (>1:2 serum dilution)
  • DKA + AMS = cerebral edema until proven otherwise

General Treatment

  • IV Fluids
    • NS @ 10ml/hr/kg for stable VS
    • Bolus 20ml/kg NS only for unstable VS
    • Replace fluid deficit evenly over 48hr w/ NS or 1/2 NS
    • When BS <250:
      • Change fluid to D51/2NS @ rate to correct fluid deficit in 48hr; maintain BS 150-250
  • Insulin
    • IV Infusion 0.1 units/kg/hr
      • Cont until HCO3 > 15 and pH>7.3
    • Decrease infusion to 0.05 u/kg/hr until 1hr after SC insulin initiated
  • Potassium
    • if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
      • No insulin until K > 2.5
    • if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5
    • if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5
    • if > 5.5, then check K q1hr
  • Bicarbonate
    • Only consider for:
      • Critically ill (hemodynamic compromise from decr contractility) AND
      • pH <7.0
    • 0.5-2 mEq/kg over 1-2hr
    • Correction should never exceed pH > 7.1 or bicarb >10

Disposion

  • Admit all unless
    • Known diabetes
    • pH >7.35 and bicarb >20
    • Known and resolving precipitant for DKA

Complications

See Also

Diabetic Ketoacidosis (DKA)

Source

Tintinalli

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